Doctors: Anthem Not Paying For Psychotherapy In Some Cases

Several doctor organizations are criticizing Anthem Blue Cross and Blue Shield in Connecticut for not covering psychotherapy in some cases after a Jan. 1 change in medical-billing codes.

Anthem has responded to changes in medical-billing codes for psychiatry by covering only visits for an evaluation or management of medical issues, and not psychotherapy as a separate equal category when provided during the same visit, according to the Connecticut Psychiatric Society, the American Psychiatric Association and the Connecticut State Medical Society.

"They're only reimbursing for one when both are provided," said Matthew C. Katz, chief executive of the Connecticut State Medical Society.

By not covering psychotherapy, psychiatrists have a choice of denying patients an important part of their treatment, or suggesting that they seek therapy separately.

Anthem isn't paying for psychotherapy when it is provided in conjunction with other medical services, though the insurer is paying for psychotherapy when it is provided alone, Katz said.

The most recent version of "current procedural terminology," or CPT, medical-billing codes came out in October and took effect Jan. 1, Katz said. An updated version comes out every year. Psychotherapy has been isolated as a separate service in the past, but with different codes, Katz said.

The three medical groups claim Anthem is violating state and federal laws and regulations related to mental health treatment and substance-abuse treatment by not recognizing that those treatments are billable medical services just as other medical services and are separate and distinct, Katz said.

"These practices are both unethical and illegal," said the American Psychiatric Association's chief executive Dr. James H. Scully, Jr. "We worked very hard to enact mental health parity laws, and it is now clear that Anthem is seeking a way to avoid compliance. We are not prepared to allow them to skirt their obligations under the law."

Wallingford-based Anthem is the largest health insurer in the state by membership. The company did not have an immediate reply Thursday afternoon.